General Description
Tiopronin is a synthetic mercaptoacyl derivative with a thiol group, structurally related to cysteine. Its chemical structure is 2-(2-sulfanylpropanamido)acetic acid. Tiopronin is a white to off-white crystalline powder, soluble in water and alcohol. The molecule contains a chiral center, and the drug is available as the racemic mixture.
Mechanism of Action
Tiopronin acts as a reducing agent, breaking the disulfide bonds in cystine and forming a soluble mixed disulfide of tiopronin and cysteine. This reduces the concentration of cystine in the urine, preventing the formation of cystine stones. The drug also has antioxidant properties, scavenging reactive oxygen species (ROS) and protecting cells from oxidative damage.
Application
Tiopronin is indicated for the prevention of cystine kidney stones (cystinuria) in patients who are not responding to conservative measures such as high fluid intake and alkalinization. It is also used for the treatment of rheumatoid arthritis and for the management of heavy metal toxicity. The drug is effective in reducing the frequency of stone formation and the need for surgery.